Dimensions 1-2 Westbury Way

Dimensions 1-2 Westbury way is a residential care home providing the regulated activity of accommodation and personal care. The service provides support to six people with a learning disability.

The service is made up of two bungalows located on a residential street, each accommodates three people and are linked via an office area. Each bungalow has its own dining room, kitchen and bathroom facilities. People have their own bedrooms and access to a secure garden area.

People’s experience of using this service and what we found

We received positive feedback from relatives and professionals that the service was well-led. We observed there had been vast improvement in the way the provider monitored and acted on environmental issues and repairs and reviewed evidence which demonstrated they had acted on our feedback from the last inspection to improve the quality of the service people received. We recommended further development to ensure records related to people’s care were consistently reviewed inline with the provider’s planned timescales.

We received consistently positive feedback from staff, relatives and professionals that people received safe care and support from staff that knew them and their needs well. Risks to people were identified, assessed and managed and people had access to appropriate levels of skilled staff to meet their needs. People were supported to manage and receive their medicines safely, and there were clear safeguarding systems in place to report and respond to any risk of abuse.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: We received feedback from people’s relatives that the care provided to their loved ones was person-centred and staff knew people and their needs well. We observed staff treated people with kindness and compassion, however our judgement on this aspect of the ‘Right support, right care, right culture’ guidance is limited as this was a focused inspection that considered the areas of safe and well-led only.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff promoted inclusivity which recognised the importance of providing opportunities for people to lead empowered lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 March 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found enough improvements had been made and the provider was no longer in breach of regulations. However, we have recommended that the provider should continue to embed and strengthen areas of their governance processes to ensure records relating to people’s care and support are continually reviewed and updated in a timely manner.

Why we inspected

At the last inspection we found the provider was in breach of regulation. This inspection was carried out to review actions the provider told us they would take to comply with the regulation and improve the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dimensions 1-2 Westbury Way on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dimensions 1-2 Westbury Way is a residential care home providing the regulated activity of accommodation and personal care to six people with a learning disability.

Although the location is registered as a care home, the building from which the location is operated is separately owned by a housing association who are responsible for its maintenance .

The service which is located in a residential street, comprises of two linked bungalows, each of which has three bedrooms, a kitchen, dining room, lounge, bathroom and cloakroom.

People’s experience of using this service and what we found

We saw there were a range of maintenance issues with the property, some of which had been present for a significant period of time, which had negatively impacted upon people’s safety and quality of life. The poor condition of the property had negatively impacted staff’s ability to protect people from the risk of catching COVID-19. The provider’s processes had not been used effectively to escalate issues when the housing association failed to complete the required repairs in a timely manner. Notifications had not been submitted to CQC as required. The provider took immediate action to address these issues when we spoke with them after the site visit.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the key questions safe and well-led, the service was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. Actions taken to ensure people’s right to live in a home which was fit for purpose and well-maintained had not been effective. The provider once aware of the extent of the issues, took immediate action and devised an action plan to address this for people and ensured the required works were completed.

Potential risks to people related to their care had been identified, assessed and managed. There were sufficient staff for the service. The provider had taken all practicable measures to staff the service. There were robust recruitment processes. Processes were in place to safeguard people from the risk of abuse. People received their medicines safely from trained staff.

The provider had a clear vision for delivery of the service and promoted an open culture. They acted with integrity and were immediately responsive to our feedback. Relatives and staff felt the service was well-led and that they could speak with the registered manager. Stakeholders provided positive feedback on the service,

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 30 June 2017).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns. The inspection was prompted in part due to concerns about a recent outbreak of COVID-19. A decision was made for us to inspect and examine those risks.

We inspected and found there were also concerns with the environment, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dimensions 1-2 Westbury Way on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to premises, governance and notifications at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an updated action plan from the provider to understand what they will continue to do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rating at last inspection

At the last inspection, the service was rated good.

At this inspection we found the service remained good.

Why the service is rated good.

Processes and procedures were in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse and infection. Appropriate recruitment procedures were in place and sufficient staff rostered to ensure people’s safety. Medicines were managed safely within the service. Processes were in place to ensure learning took place from incidents.

Staff received training to maintain and develop their skills and knowledge in order to support people effectively. The registered manager had taken action to ensure staff received the provider’s required number of supervisions. People were supported by staff to eat and drink sufficient for their needs. Staff worked across organisations to ensure people received effective care which met their health care needs. The environment was purpose built for people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff had developed caring and kind relationships with the people they supported. People were supported by staff to be involved in decisions about their care wherever possible. Staff ensured people’s privacy and dignity was upheld during the provision of their care.

People’s care was based on support plans, which took into account people’s needs and preferences. People were able to take part in leisure activities, which reflected their interests. People and their relatives were provided with information about the provider’s complaints procedure.

There was a warm, friendly and home-like atmosphere. People’s relatives and staff were engaged with the service. Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided. The service has sustained the improvements they have made in the key area of well-led, which is now rated good.

Further information is in the detailed findings below.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 8 June 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this legal requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Dimensions 1-2 Westbury Way‘ on our website at www.cqc.org.uk.

Dimensions 1-2 Westbury Way is registered to provide accommodation and support for up to six people with learning and physical disabilities. At the time of our inspection six people were living at the service.

The service had a registered manager; they were away at the time of the inspection. We were supported during the inspection by the head support worker. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our focused inspection on the 8 June 2017, we found that the provider had followed their action plan which they had told us would be completed by the 31 March 2016 and legal requirements had been met. We will review our rating for well-led at the next comprehensive inspection.

Records demonstrated that risks to people had been identified, documented and addressed for their safety. Records showed that an activity which provided one person with pleasure, but was a known risk to their health, had been assessed and written measures were in place to safely manage the associated risks. Where people lacked the capacity to make a specific decision about their lives legal requirements had been met. All of the documents to demonstrate safety checks had been carried out as required in relation to utilities and equipment safety were readily available.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Records did not always fully document actions in place to protect people from identified risks, or demonstrate processes completed to support lawful decision-making. The registered manager was in the process of reviewing paperwork to ensure records were current, complete and accurate, with older records archived.

People were protected from abuse, because support workers understood how to identify and report concerns. Posters in the home reminded support workers of the importance of reporting any concerns.

Equipment and utilities were serviced regularly, and internal checks protected people and others from potential risks in the home. Risks affecting individuals had been identified, and measures put into place to protect them from harm.

People were supported by enough support workers to meet their needs and wishes. Rosters were planned to ensure people were supported to attend planned activities and appointments. Recruitment procedures ensured people were supported by suitable staff to deliver people’s care and support safely.

People were administered their prescribed medicines safely, because support workers had been trained and assessed to ensure they did this competently. Medicines were stored safely, and records and audits demonstrated that support workers ensured people took their prescribed medicines safely.

Support workers completed and refreshed training to ensure they maintained the skills required to meet people’s needs effectively. Training specific to individual’s needs ensured support workers were able to provide each person with support and care appropriate to their needs and wishes.

Support workers understood and implemented the principles of the Mental Capacity Act 2005. They supported people to make decisions about their care where possible, and followed people’s consent or refusal. They understood the process of mental capacity assessment and best interest decision-making where people lacked the capacity to make an informed decision about their care. Applications for Deprivation of Liberty Safeguards had been made appropriately when restrictions were in place to protect people from identified harm.

People were protected from the risks of dehydration or malnutrition because they were supported to maintain a healthy balanced diet. Risks and health conditions affecting people’s nutrition were understood and managed to ensure their dietary intake was supported effectively. People were supported to keep well through effective liaison with health professionals as required.

People were supported by caring and kindly staff. Support workers understood how people indicated their wishes, and provided care in accordance with this. People’s dignity was promoted and their privacy was respected.

Support plans reflected people’s preferences and needs, and were reviewed at least annually with those important to them to ensure changes were identified and adressed.

Relatives told us they had no reason to complain, because good communication effectively dealt with any concerns they raised promptly. Feedback from people and their relatives was sought to identify any improvements required for people’s care and support.

Support workers understood the provider’s ethos of supporting people to live fulfilled lives. They supported people to communicate their wishes, and implemented actions to support people to live their lives contentedly.

Relatives and support workers described the registered manager as supportive and effective in her role. A management network provided support and guidance for all staff to ensure people received their planned care.

Internal audits informed the service improvement plan, which was used to identify and drive improvements to the quality of care people experienced.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found that although people who used the service were unable to give consent to changes to their care and treatment the provider would always carry out an assessment of their capacity to make decisions every time a such a change was needed, and if necessary a best interest meeting was arranged.

We found that relatives, speaking on behalf of people who used the service, were very satisfied with the level of care offered in the home. One said: 'I could live here myself'. We also found that each person had an effective care plan which was kept updated, and that staff engaged caringly and sensitively with people.

We found that the premises was safe and suitable for its purpose. However, we did find an issue with a broken fence which presented a potential security risk.

We found that staff were properly supported, with a proper induction, regular training, supervision and appraisal, and opportunities for further development.

We found that the provider had effective systems and processes in place to monitor and assess the quality of the service, although relatives did not like the feedback questionnaire given to them.